Healthcare Provider Details

I. General information

NPI: 1285569806
Provider Name (Legal Business Name): VANESSA VALEZA CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

IV. Provider business mailing address

208 MIDDLEWAY RD APT 3A
MIDDLE RIVER MD
21220-3829
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3000
  • Fax:
Mailing address:
  • Phone: 667-310-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR257930
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: